title: The blue man: burn from muriatic acid combined with chlorinated paint in an adult pool construction worker.
abstract: Muriatic acid (hydrochloric acid), a common cleaning and resurfacing agent for concrete pools, can cause significant burn injuries. When coating a pool with chlorinated rubber-based paint, the pool surface is initially cleansed using 31.45% muriatic acid. Here we report a 50-year-old Hispanic male pool worker who, during the process of a pool resurfacing, experienced significant contact exposure to a combination of muriatic acid and blue chlorinated rubber-based paint. Confounding the clinical situation was the inability to efficiently remove the chemical secondary to the rubber-based nature of the paint. Additionally, vigorous attempts were made to remove the rubber paint using a variety of agents, including bacitracin, chlorhexidine soap, GOOP adhesive, and Johnson's baby oil. Resultant injuries were devastating fourth-degree burns requiring an immediate operative excision and amputation. Despite aggressive operative intervention and resuscitation, he continued to have severe metabolic derangements and ultimately succumbed to his injuries. We present our attempts at debridement and the system in place to manage patients with complex chemical burns.
authors.affiliation: From the Department of Surgery, Arizona Burn Center, Maricopa Integrated Health Systems, Phoenix.
authors.forename: Marc R
authors.initials: MR
authors.lastname: O'Cleireachain
authors.forename: Luis H
authors.initials: LH
authors.lastname: Macias
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Richey
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Pressman
authors.forename: Gina R
authors.initials: GR
authors.lastname: Shirah
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Caruso
authors.forename: Kevin N
authors.initials: KN
authors.lastname: Foster
authors.forename: Marc R
authors.initials: MR
authors.lastname: Matthews
mesh_terms: D002057:Burns, Chemical / Q000209:etiology* / Q000601:surgery; D002424:Caustics / Q000633:toxicity*; D002713:Chlorine / Q000032:analysis / Q000633:toxicity*; D017809:Fatal Outcome; D006801:Humans; D006851:Hydrochloric Acid / Q000633:toxicity*; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects*; D010150:Paint / Q000633:toxicity*; D013551:Swimming Pools
chemical_list: D002424:Caustics; D002713:Chlorine; D006851:Hydrochloric Acid